Sprains and strains: first aid, recovery and getting back to activity

A twisted ankle on an uneven road, a pulled muscle while playing sport or a wrist that bends the wrong way after a slip are everyday injuries. Knowing the first steps and the warning signs helps you recover well and avoid problems. This article explains sprains and strains, early home care, recovery and when to get urgent help, using information from the NHS and MedlinePlus.

1. Introduction

The NHS says sprains and strains are common injuries to ligaments and muscles, and that most can be treated at home ^[1]. It explains the difference clearly ^[1]:

• A sprain is a twisted or torn ligament. Ligaments are strong bands of tissue that connect bones at a joint. Sprains are common in the ankles, wrists, thumbs and knees.
• A strain is an overstretched or torn muscle, also called a pulled muscle. Strains are common in the feet, legs and back.

MedlinePlus describes a sprain as a stretched or torn ligament ^[2]. MedlinePlus adds that a strain can involve a tendon, the tissue that connects muscle to bone, and that falls, twists or blows can cause a sprain ^[2]. Its ankle page explains that ligaments keep the ankle joint stable and that a sprain is an injury to these ligaments ^[3].

2. Signs and symptoms

The NHS lists these signs of a sprain or strain ^[1]:

• Pain, tenderness or weakness
• Swelling or bruising
• Difficulty putting weight on the area or using it normally
• Muscle spasms or cramping

MedlinePlus adds that you may feel a pop or tearing at the time of the injury ^[2].

3. Causes and risk factors

Sprains and strains happen when a joint is twisted or a muscle is overstretched. The NHS notes that not warming up before exercise, tired muscles and playing sport can all contribute ^[1].

4. Diagnosis and tests

Many people do not need tests. The NHS says that if a broken bone is suspected, an X-ray may be arranged at an urgent treatment centre or hospital. You may also be given self-care advice or a stronger painkiller, or be referred to hospital ^[1]. Because a fracture can feel like a bad sprain, the signs listed in the section on when to see a doctor are important.

5. Treatment and management

The first two to three days

For the first two to three days the NHS suggests using the PRICE steps ^[1]:

1. Protection: protect the injury, for example with a support or supportive footwear.
2. Rest: stop the activity and avoid putting weight on the area.
3. Ice: apply a cold pack, or frozen vegetables wrapped in a towel, for up to 20 minutes every two to three hours.
4. Compression: wrap a bandage around the area for support during the day.
5. Elevation: keep the injury raised, ideally on a pillow.

To limit swelling in the first couple of days, the NHS advises avoiding heat such as hot baths and heat packs, avoiding alcohol and avoiding massage. MedlinePlus likewise describes resting, icing and compressing the area as the usual first steps ^[2]. A pharmacist can suggest suitable pain relief or products for swelling ^[1].

Moving again

Once pain allows, the NHS says to gently keep the joint or muscle moving to prevent stiffness ^[1]. MedlinePlus says exercise and physical therapy may follow in the later stage of care ^[2].

Recovery

The NHS says most sprains and strains improve within about two weeks, and that strenuous activity such as running should be avoided for up to eight weeks to lower the risk of injuring the area again. Severe injuries can take months to recover fully ^[1]. MedlinePlus notes that ankle sprains can take from a few weeks to many months to heal ^[3].

Physiotherapy

If recovery is slow, the NHS says physiotherapy may help. In many areas of the UK people can refer themselves to community musculoskeletal services, and private physiotherapy is also an option ^[1]. The NHS says NHS physiotherapy is not available everywhere and waits can be long, and it points to a directory for finding a private physiotherapist ^[1].

Prevention

The NHS says sprains and strains cannot always be prevented, but warming up before exercise and being aware of muscle tiredness during sport may reduce the risk ^[1].

6. When to see a doctor

The NHS advises urgent medical advice if ^[1]:

• Pain is severe or getting worse
• Swelling or bruising is large or worsening
• You cannot put any weight on the limb or walk more than a few steps
• There is marked stiffness or trouble moving the area
• You have not improved after self-care
• You have a very high temperature or feel hot, cold or shivery, which could be a sign of infection

See a doctor if symptoms are getting worse or not improving after self-care ^[1].

Go to hospital urgently if you heard a crack when you were hurt, the limb looks out of shape or at an odd angle, you have numbness, tingling or pins and needles, or the skin turns blue or grey or feels cold. The NHS says not to drive yourself to hospital and to bring your medicines ^[1]. In an emergency, call your local emergency number (112 in India, 911 in the United States).

7. Conclusion

Sprains are injured ligaments and strains are injured muscles, and most improve with early protection, rest, ice, compression, elevation and a gradual return to movement. Recovery usually takes weeks, and longer for severe injuries. Know the warning signs of a more serious injury, and ask for physiotherapy if progress is slow. Your doctor decides on any further treatment.